A multidisciplinary approach along the entire patient journey from pre-hospital care to hospital discharge is needed to ensure early recognition, risk stratification, and the benefit of available therapies. Medical management should be planned according to the underlying mechanisms of various clinical scenarios of AHF.

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Background and Objective. The objective of our study was to evaluate the predictive power of a combined assessment of heart rate variability (HRV) and impedance cardiography (ICG) measures in order to better identify the patients at risk of serious adverse events after ST-segment elevation myocardial infarction (STEMI): all-cause or cardiac mortality (primary outcomes) and in-hospital recurrent ischemia, recurrent nonfatal MI, and need for revascularization (secondary outcomes). Material and Methods. A total of 213 study patients underwent 24-hour electrocardiogram (used for HRV analysis) and thoracic bioimpedance monitoring (used for calculation of hemodynamic measures) immediately after admission. The patients were examined on discharge and contacted after 1 and 5 years. Cox regression analysis was used to determine the predictors of selected outcomes. Results. The standard deviation of all normal-to-normal intervals (SDNN) and cardiac power output (CPO) were found to be the significant determinants of 5-year all-cause mortality (SDNN ≤100.42 ms and CPO ≤1.43 W vs. others: hazard ratio [HR], 11.1; 95% CI, 4.48–27.51; P<0.001). The standard deviation of the averages of NN intervals (SDANN) and CPO were the significant predictors of 5-year cardiac mortality (SDANN ≤85.41 ms and CPO ≤1.43 W vs. others: HR, 11.05; 95% CI, 3.75–32.56; P<0.001). None of the ICG measures was significant in predicting any secondary outcome. Conclusions. The patients with both impaired autonomic heart regulation and systolic function demonstrated by decreased heart rate variability and impedance hemodynamic measures were found to be at greater risk of all-cause and cardiac death within a 5-year period after STEMI. An integrated analysis of electrocardiogram and impedance cardiogram helps estimate patient’s risk of adverse outcomes after STEMI.

BackgroundThis study aimed at evaluating the diagnostic and outcome prediction value of transthoracic impedance cardiography (ICG) in heart failure (HF) patients admitted for in-hospital treatment due to flare-ups of their condition.Material/MethodsIn total, 120 patients of intensive care units who were admitted due to HF flare-ups were involved to the study. The findings of ICG were compared to data obtained by other methods used for diagnosing HF.ResultsStatistically significant (p<0.001) results were obtained when evaluating differences in ICG data between admission and discharge from the intensive care unit. In addition, a correlation was detected between brain natriuretic peptide (BNP) and thoracic fluid content index (r=0.4, p<0.001). Differences in ICG values, and BNP data emerged after the participants were grouped according to NYHA classes (p<0.05). The evaluation of lethal outcome during 6 months after the discharge yielded statistically significant results: BNP ≥350 pg/mL (Odds Ratio (OR) 4.4), thoracic fluid content ≥34 1/kOhm (OR 4.3), and systolic time ratio ≥0.55 (OR 2.9), p<0.05.ConclusionsICG data might be applied for the diagnosis and prognosis of HF, although the links between ICG and HF need further evaluation.

BackgroundHeart failure (HF) accounts for about 5% of all causes of urgent hospital admissions, and the overall mortality of HF patients within 1 year after hospitalization is 17–45%. Transthoracic impedance cardiography (ICG) is a safe, non-invasive diagnostic technique that helps to detect various parameters that define different cardiac functions. The aim of this study was to investigate the value of ICG parameters in patients hospitalized due to HF flare-ups.Material/MethodsThe study included 60 patients (24 women and 36 men) who were admitted to intensive care units because of an acute episode of HF without signs of myocardial infarction. The diagnosis of HF as the main reason for hospitalization was verified according to the universally accepted techniques. ICG data were compared to those obtained via other HF diagnostic techniques.ResultsA moderately strong relationship was found between the ejection fraction (EF) and the systolic time ratio (STR) r=−0.4 (p=0.002). Findings for STR and thoracic fluid content index (TFCI) differed after dividing the subjects into groups according to the EF (p<0.05). A moderately strong relationship was found between brain natriuretic peptide and TFCI r=0.425 (p=0.001), left cardiac work index (LCWI) r=−0.414 (p=0.001). Findings for TFCI, LCWI, and cardiac output differed after dividing the subjects into groups according to HF NYHA classes (p<0.05).ConclusionsTransthoracic impedance cardiography parameters could be applied for the diagnostics and monitoring of HF, but further studies are required to evaluate the associations between ICG findings and HF.

Background and Objective. The objective of our study was to investigate whether the combination of markers of heart rate variability (HRV) and impedance cardiography (ICG) help evaluate the risk of in-hospital death, ventricular arrhythmia, or complicated course secondary to myocardial infarction (STEMI) and to clarify whether combined analysis of HRV and ICG improve prognosis of STEMI, comparing 3 groups: 1) diabetic, 2) nondiabetic, and 3) diabetes-unselected patients. Material and Methods. The parameters reflecting heart rate variability and central hemodynamics were estimated from a 24-hour synchronic electrocardiogram and thoracic impedance signal recordings in 232 patients (67 diabetic) on the third day after myocardial infarction. Logistic regression analysis was used to determine the predictors of selected outcomes. Different prognostic models were compared with the receiver operating characteristic curve analysis.Results. The model consisting of low- and high-frequency power ratio (LF/HF) and cardiac output (CO) was elaborated for the prognosis of in-hospital death in the group 3 (odds ratios [ORs] were 9.74 and 4.85, respectively). Very low-frequency power (VLF), cardiac index (CIN), and cardiac power output (CPO) were the predictors of ventricular arrhythmia in the group 2 (ORs of 1.005, 5.09, and 66.7, respectively) and the group 3 (ORs of 1.004, 3.84, and 37.04, respectively). The predictors of the complicated in-hospital course in the group 1 were the baseline width of the minimum square difference triangular interpolation of the highest peak of the histogram of all NN intervals (TINN) and stroke volume (SV) (ORs of 1.006, and 1.009, respectively); in the group 2, the mean of the standard deviations of all NN intervals for all 5-minute segments of the recording (SDNN index) and CPO (ORs of 1.06 and 2.44, respectively); and in the group 3, SDNN index, VLF, LF/HF, CIN (ORs of 1.04, 1.004, 2.3, and 3.49, respectively). Conclusions. The patients with decreased HRV and low estimates of central hemodynamics evaluated by ICG are at an increased risk of the adverse in-hospital course of STEMI. The combined analysis of HRV and ICG hemodynamic estimates contributes to the risk assessment of the complicated in-hospital course of STEMI, in-hospital hemodynamically significant ventricular arrhythmia, and in-hospital death secondary to STEMI. The in-hospital prognostic value of the combined estimates of HRV and ICG is lower in the STEMI patients with diabetes mellitus as compared with the nondiabetic patients.

The aim of this study was to determine the characteristics of carbapenem-resistant Pseudomonas aeruginosa (P. aeruginosa) strains and 5-year changes in resistance in a tertiary university hospital. Material and Methods. The study included 90 and 101 randomly selected P. aeruginosa strains serotyped in 2003 and 2008, respectively. The standardized disk diffusion test and E-test were used to determine resistance to antibiotics. P. aeruginosa strains were considered to have high-level resistance if a minimum inhibitory concentration (MIC) for imipenem or meropenem was >32 μg/mL. To identify serogroups, sera containing specific antibodies against O group antigens of P. aeruginosa were used. P. aeruginosa isolates resistant to imipenem or/and meropenem were screened for metallo-β-lactamase (MBL) production by using the MBL E-test. Results. Comparison of the changes in resistance of P. aeruginosa strains to carbapenems within the 5-year period revealed that the level of resistance to imipenem increased. In 2003, 53.3% of P. aeruginosa strains were found to be highly resistant to imipenem, while in 2008, this percentage increased to 87.8% (P=0.01). The prevalence of MBL-producing strains increased from 15.8% in 2003 to 61.9% in 2008 (P<0.001). In 2003 and 2008, carbapenem-resistant P. aeruginosa strains were more often resistant to ciprofloxacin and gentamicin than carbapenem-sensitive strains. In 2008, carbapenem- resistant strains additionally were more often resistant to ceftazidime, cefepime, aztreonam, piperacillin, and amikacin than carbapenem-sensitive strains. MBL-producing P. aeruginosa strains belonged more often to the O:11 serogroup than MBL-non-producing strains (51.7% vs. 34.3%, P<0.05). A greater percentage of non-MBL-producing strains had low MICs against ciprofloxacin and amikacin as compared with MBL-producing strains. Conclusions. The results of our study emphasize the need to restrict the spread of O:11 serogroup P. aeruginosa strains and usage of carbapenems to treat infections with P. aeruginosa in the intensive care units of our hospital

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